The Obamacare Train Wreck

by Andrew Stiles
Implementation hits hurdle after hurdle — let us count the ways.

The White House plans to delay yet another provision of Obamacare, the New York Times revealed on Monday, in what was described as “another setback for President Obama’s health-care initiative.” Indeed, it seems that every week the administration offers up a new example of the implementation “train wreck” of which Obamacare architect Max Baucus (D., Mont.), among others, has warned.

Here are nine examples of how Obamacare implementation hasn’t gone according to plan:

1. Caps on Out-of-Pocket Insurance Costs
The Obama administration plans to delay until 2015 a provision that limits out-of-pocket health-care costs, including deductibles and co-payments, for individuals ($6,350) and families ($12,700). In the meantime, many insurers will be able to set higher limits on out-of-pocket costs, or no limit at all.

The obscure ruling, which received attention this week despite being published on the Labor Department’s website back in February, has drawn complaints from advocacy groups representing individuals with chronic illnesses, who argue that patients requiring expensive drug treatments will face exorbitant out-of-pocket costs in the absence of caps. “The promise of out-of-pocket limits was one of the main reasons we supported health-care reform,” Theodore M. Thompson, a vice president of the National Multiple Sclerosis Society, told the New York Times.

President Obama repeatedly touted the limits on out-of-pocket expenses in his effort to win support for the law. “No one should go broke because they get sick,” Obama told a joint session of Congress in September 2009. In explaining the decision to delay the requirement, a senior administration official told the Times, “We had to balance the interests of consumers with the concerns of health-plan sponsors and carriers” who “asked for more time to comply.”

2. The Employer Mandate
Last month, the White House decided to delay the Obamacare provision requiring all businesses with more than 50 employees to provide health insurance to full-time workers or pay a fine ($2,000 per worker). Senior Obama adviser Valerie Jarrett said the unilateral delay, which will cost around $12 billion, according to the Congressional Budget Office, was evidence that the administration was “listening” to the business community.

Although some have questioned the legality of the administration’s unilateral action, the president has dismissed such criticism, telling the New York Times: “Where Congress is unwilling to act, I will take whatever administrative steps that I can in order to do right by the American people.”

In fact, the House of Representatives recently voted to enshrine the employer-mandate delay into law; Obama threatened to veto the legislation, calling it “unnecessary.” Republicans have seized on the president’s decision; arguing that big businesses shouldn’t receive special treatment, they are pushing for a delay of the even more controversial individual mandate, which is set to take effect in 2014. The House also passed a bill to delay the individual mandate for one year — with the help of 35 Democrats.

3. Anti-Fraud Measures
Days after announcing the employer-mandate delay, the Obama administration decided to delay another significant provision in the law that requires the government to verify the income and insurance status of applicants for federal health-care subsidies. The White House has put off implementation of the provision until 2015. In the meantime, according to the Washington Post, the government health-care exchanges can simply accept “the applicant’s attestation” regarding his or her eligibility and household income “without further verification” in determining the allotment of taxpayer subsidies.  

4. CLASS Act
The “fiscal cliff” deal enacted earlier this year repealed a provision of the health-care law known as the CLASS Act, a long-term-care insurance plan championed by the late Senator Ted Kennedy (D., Mass.), after the administration was forced to acknowledge that the program was fiscally unsustainable. The CLASS Act was inserted into the law despite repeated warnings from Medicare’s chief actuary that the program “doesn’t look workable.” Even former senator Kent Conrad (D., N.D.) described it as “a Ponzi scheme of the first order.” Additionally, the CLASS Act — which was designed to collect five years’ worth of premiums before paying out any benefits, and therefore was scored as reducing the deficit by $70 billion — was critical in lowering the projected fiscal impact of Obamacare, at least on paper.

5. Independent Payment Advisory Board (IPAB)
The 15-member board of health-care experts and professionals, which will have sweeping authority to make cuts and reforms to Medicare reimbursements to doctors, is supposed to begin work in 2014. However, the administration is having a difficult time finding anyone who is willing to serve on the controversial panel. A number of Democrats, including former Democratic National Committee chairman Howard Dean and former representative Barney Frank (D., Mass.), have called for repealing IPAB; 22 Democrats have co-sponsored House legislation to do just that.

6. Cuts to Medicare Advantage
Obamacare’s cuts to Medicare Advantage funding (about $500 billion in total) were initially scheduled to take effect in 2012. However, those cuts would probably have caused many seniors to lose their preferred health-care plans — right before a consequential election. Accordingly, the administration decided to postpone the impact of the cuts for a year by spending $8 billion on a “demonstration project” ostensibly intended to shore up Medicare Advantage funding and “study” the results. The nonpartisan GAO complained about the highly political nature of the study, which was slated to be more expensive than “all other Medicare demonstrations conducted since 1995 combined,” and recommended that the cuts proceed as planned, advice the administration promptly ignored.

7. 1099 Tax-Reporting Mandate for Businesses
Obamacare initially required small businesses to file an additional 1099 tax form each year for every business with which they had conducted more than $600 in transactions. The provision, which businesses obviously hated, was intended to raise about $17 billion in revenue, by both imposing new taxes and making it harder for people to avoid business taxes. But after both parties realized that the burden placed on small businesses would be too onerous, Congress passed a law in 2011 that repealed the requirement. The lost revenue was offset by reducing certain health-insurance tax credits in the law. The 1099 repeal was the first of several pieces of legislation that have rolled back major provisions of Obamacare.

8. Democratic Defections
As Obamacare’s implementation has proved increasingly problematic, and as public support for the law continues to wane, Democrats have become more willing to oppose the law and many of its key provisions. A growing number of Democrats support the repeal of IPAB, and last month 35 House Democrats voted with Republicans to delay the individual mandate for one year. Almost all of them represent competitive House districts and will face tough reelection fights in 2014. Two of those Democrats, Representatives Bruce Braley (Iowa) and Gary Peters (Mich.), are running for Senate next year and are generally considered favorites to win — an indication that opposition to Obamacare makes for good politics, and that some Democrats are catching on.

9. Waivers and Missed Deadlines
All of this is in addition to myriad missed deadlines (for example, the federal government is likely to miss the upcoming October 1 deadline for setting up insurance exchanges in more than 30 states) as well as more than a thousand waivers, many of them handed out to political cronies, which have plagued the administration’s rollout of Obamacare.
 

Given these many recent complications, perhaps it’s no wonder Democrats are once again pining for a single-payer health-care system. Of course, if you believe Senate majority leader Harry Reid (D., Nev.), that’s been the ultimate goal all along.

— Andrew Stiles is a political reporter for National Review Online.

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